Researchers have dug deep into the link between asthma and obesity, but have yet to determine exactly how the two conditions interact, and whether one causes the other. However, it has been shown that shedding some pounds can result in fewer asthma symptoms. In obese asthmatics (defined as having a body mass index of 30 or greater), even losing 10 to 15 per cent of body weight can make a difference.

Dr. Corinna Bowser, an allergist at the Thomas E. Klein clinic near Philadelphia, counsels her overweight asthma patients to slim down to help with asthma control. “The more weight you carry on you, especially if it’s around the abdomen, the more it pushes up and decreases the ability of your lungs to work properly,” she explains.

The keys to weight loss are exercise and healthier eating. If you’re not used to working out, start by making small changes such as taking a flight of stairs at work rather than the elevator, or getting off one bus stop before your destination and walking the rest of the way. As a bonus, your lungs will get many other benefits from a consistent exercise routine. (See Strategy 5.)

As for the food you eat, the basics of a weight-loss diet are actually quite simple: start the day with a good breakfast, and eat regular balanced meals and snacks. “If you’re just eating a salad and bread for lunch, then chances are pretty good that you’re going to crave something sweet in the afternoon,” explains Toronto dietitian Rosie Schwartz.

Strategy 2: Eat Greek

When it comes to diet, people living along the Mediterranean Sea have been getting it right. Their traditional fare – full of fruits and vegetables, legumes, fish, nuts and whole grains – is high in antioxidants and omega-3 fatty acids, two highly sought after food components these days.

In the past few years, it has become clear that eating a Mediterranean diet has a positive effect on children and results in fewer asthma symptoms, such as wheezing. Recently, researchers have traced the advantage right back to the womb: a study from Crete showed a protective effect against children developing asthma when their mothers ate a “high quality” Mediterranean diet while pregnant.

To add to the case for “going Mediterranean,” research released in July suggests the benefits are not only for kids. A study from the University of Porto in Portugal found an improvement in asthma control in adults with this same style of diet. Snacking on carrots, apples and nuts (if you’re not allergic), dining on fresh fish and pasta tossed in olive oil, and finishing the day off with a glass of red wine is not only a delicious regimen, it may help you to breathe easier.

Strategy 3: Develop a Taste for Fish

Back in the 1980s, scientists began to notice that the Inuit, whose traditional diet is rich in omega-3 fatty acids, had low rates of inflammatory conditions such as cardiovascular disease and asthma. Since then, researchers around the world have been trying to find ways to make omega-3s useful in preventing or treating such diseases.

So far, it has been shown that omega-3s are quite effective in reducing cardiovascular risk. However, “allergic disease is way behind cardiovascular research,” says John Brannan, a PhD in pharmacology from Australia, who has come to McMaster University and the Firestone Institute for Respiratory Health in Hamilton, Ontario to research fish oil and asthma.

In his study, Brannan is trying to replicate recent research that finds fish oil, in high doses, effective at treating exercise-induced asthma. He wants to take the research a step further as well, and see whether fish oil has a positive effect in cases of severe exercise-induced asthma.

At this point, Brannan doesn’t foresee fish oil caplets becoming a standard treatment for asthma, in part because of the high dose being used in the current research (about 20 times the amount in a capsule from the drugstore). However, he doesn’t discourage people from taking omega-3 supplements*, particularly if they’re not eating fish with high amounts of omega-3s, such as salmon, herring and tuna, as part of their regular diet.

“I think the bottom line is more [research] needs to be done,” he says. “It’s exciting though. The potential anti-inflammatory properties of [omega-3s] are definitely something that requires more investigation.”

Strategy 4: Relax and Rejuvenate

Many people know stress triggers their asthma, while others swear it doesn’t play a role. But studies have now proved what once seemed dubious: constant worry and stress can bring on symptoms on full bore. To make matters worse, the wheezing and coughing from your asthma can cause you more concern, increasing the feelings of anxiousness and panic, and likely making your symptoms worse.

As with all triggers, it’s best to avoid stress. But there will be times when that’s simply not possible. “It’s hard to tell the patient, ‘just relax,’” says Bowser. If a person has a severe asthma flare-up while dealing with a particularly anxious time, such as the death of a family member, that person may need to be put on oral corticosteroids, such as prednisone.

Next: The verdict on yoga for asthma

The effects of longer term stress may not be evident to the patient and the person’s physician. So besides triggering asthma symptoms, this kind of stress can have an impact on how well an individual controls the disease.

“Chronic stress can contribute to not managing their disease proactively,” notes Dr. Christine Jenkins, head of the Airways Group at the Woolcock Institute of Medical Research in Sydney, Australia. “They may not maintain lifestyle behaviours that are good for their asthma, such as sleeping, eating, exercising well, and they may forget to take their medications.”

Keeping yourself healthy will help to curtail your stress level and prevent your asthma from going into overdrive when a taxing or hectic time does occur. Relaxation exercises such slow, deep breathing and shoulder and neck rotations can assist in relieving the tension that builds up from long days at the office or from shuttling your kids around town in rush hour. A healthy diet once again comes into play, and it’s important to get an adequate amount of sleep.

While yoga[1] is a time-honoured way to reduce stress, it has also been shown in a few studies to be directly helpful to reducing asthma symptoms. Similarly, a study published in October found that six weeks of Tai Chi training contributed to significantly better lung functioning among middle-aged asthma sufferers – and improved their quality of life.

Jenkins adds one qualification: some acute stress, which induces adrenalin, might actually be good for asthma, since adrenalin is a bronchodilator; it opens up the airways briefly. But as for stress that comes from the daily grind, there are great advantages in taking steps to reduce that.

Strategy 5: Work out Regularly

All asthmatics should take the time to exercise. “I tell my patients: ‘It’s the one trigger I don’t want you to avoid,’” says Amy Kropf, a registered respiratory therapist and certified respiratory educator at St. Mary’s General Hospital in Kitchener, Ontario.

For one, if a patient sits on the couch all day, he may not be aware that his asthma isn’t under control. By exercising and pushing himself, he’ll realize his limits, and can begin to find the right medication to ensure he can exert himself without developing symptoms.

But beyond that, exercising will improve the efficiency of the person’s lungs, teaching them to work with what they’ve got. “Asthma can get worse if you don’t do something regularly, like playing outdoors for kids, or just going for a walk for elderly people,” says Bowser.

While the many other benefits of exercise are well known – improving muscle strength and endurance, improving flexibility and posture – what’s also important with asthma is that “it actually improves your ability to relax,” says Kropf.

For those whose asthma is triggered by exercise, it’s important to use a short-acting bronchodilator 15 minutes before hitting the treadmill or ice rink. “It’s a matter of controlling their asthma well enough so they don’t have these exacerbations when they exercise,” says Bowser.

Strategy 6: Breathe Better

For years, people have tried to “fix” their asthma by changing the way they breathe. In the 1950s, Russian professor Konstantin Buteyko developed a method to reverse “over-breathing” – and it is now practised throughout the world by people who want to treat their condition without medication.

Another technique, the Papworth method, is used by physiotherapists and includes breathing with your diaphragm and relaxation techniques.

Medical asthma guidelines typically don’t include breathing techniques as a way to treat asthma, because there hasn’t been enough independent research to prove that breathing methods are effective. While practitioners of these techniques have done their own studies, “there’s nothing really that’s been supported by the Canadian asthma guidelines,” says Kropf.

At Sydney’s Woolcock Institute of Medical Research, Dr. Christine Jenkins looked at the research that had been done and wondered: Could the breathing techniques be helpful in reducing symptoms and reliever use when used alongside traditional asthma medications? She devised a study to see if people who mastered these styles of breathing could decrease the amount of both the reliever and controller medications they were taking.

She had the asthma patients divided into two groups, and then each were given a set of breathing techniques to learn. One was similar to Buteyko, and included methods called nasal breathing, prolonged pause, (a slow breath out, and reducing the frequency of breaths) and shallow breathing. The other group learned relaxation and diaphragmatic exercises modeled after the Papworth method, as well as shoulder and neck rotations.

Patients mastered the techniques for 12 weeks, and were told to try the new breathing regime instead of using their inhaler when they experienced asthma symptoms. (Of course, if they felt they really needed the inhaler, they were to use it.) After the 12-week period, doctors assessed each patient’s asthma control. In those whom it was well-controlled, they then attempted to reduce the amount of controller medication.

*Do not take Omega 3 supplements derived from fish oils if allergic to fish.

Next: The bottom line

The study found that, with both sets of techniques, the patients were able to reduce reliever inhaler use by 86 per cent, and controller use by up to 50 per cent.

Jenkins was surprised by the results. “The one we thought was going to be better was the one with nasal route of breathing [modeled after Buteyko],” she says. “The other set we thought wasn’t going to help. We used them more or less as a placebo.” But in fact patients who used either set of techniques had the same result.

Patients reported that when they experienced severe asthma symptoms, they still needed an inhaler. But when the symptoms were less intense, the breathing exercises alone sufficed. “We believe that’s because of a delaying mechanism where patients feel they have control and they can take some steps without using their reliever,” says Jenkins. “Their symptoms may only be short-lived, and they’re going to settle anyway, so they don’t reach for the reliever so promptly.”

As for the reduction in controller medication, this study did not show that the breathing techniques can reduce inflammation in the airways, the underlying condition in asthmatics. However, doctors partly prescribe the amount of inhaled corticosteroid according to how often the patient requires his reliever inhaler. Therefore, an asthma sufferer may see the dosage of his controller medication reduced if the number of times a week he takes a puff of the reliever has decreased for a period of time.

Jenkins and her colleagues created a video that explains the two techniques and it’s available free from the Cooperative Research Centre for Asthma and Airways. See it here[2].

Strategy 7: Butt Out!

“Everybody knows smoking is not a good thing if you have asthma,” says Bowser. Yet, many asthmatics continue the dangerous habit, and others won’t even quit for their children’s health: a study in Manitoba found that parents of children who were diagnosed with asthma were no more likely to quit than other parents.

Smoke can trigger an asthma attack in just about anyone who has the disease, as it leaves irritating substances in the lining of the airways. Smoke also causes the lungs to create more mucus, while at the same time causing damage to the cilia, tiny hair-like structures in the airways that are meant to sweep out dust and mucus.

Although smoking asthmatics should quit, it’s equally important for non-smokers to avoid being exposed to it second-hand. “Always follow a smoke-free living environment,” advises Jan Haffner, vice-president of health initiatives for the Lung Association of Saskatchewan. “Not only in the home or in the vehicle, but the workplace and recreationally as well.”

The Bottom Line: the leaner, fitter, more relaxed, smoke-free individual is likely to have fewer symptoms. And if you stick to an asthma medication plan that works for you, master some breathing techniques, and perhaps practice a little Ashtanga yoga[1]? You’ll likely not only breathe better, but feel better for it.